AB1023 CHARACTERISTICS OF PATIENTS REFERRED FOR FIRST BONE DENSITOMETRY TO A RHEUMATOLOGY FLS, WITH NORMAL RESULTS IN THE LUMBAR SPINE
Authors: J. Rosas, J. C. Cortés-Quiroz, C. Raya-Santos, C. Cano, A. Pons, M. Lorente Betoret, J. M. Senabre-Gallego, G. Santos Soler, J. A. Bernal, X. Barber, J. A. García-Gómez
Journal: Annals of the Rheumatic Diseases (2022)

Objectives To analyze the characteristics of postmenopausal women referred for the first bone densitometry (BMD), with normal results in the lumbar spine. Methods Retrospective study of postmenopausal women, for a first BMD, at a rheumatology FLS, during February/2010-December/2021. General patient data (age, gender), osteoporosis (OP) risk factors were collected: age at menopause, parental hip fracture, body mass index (BMI), smoking and alcohol habit, drugs and potentially osteopenizing diseases, low-impact fractures in adulthood (fractures of osteoporotic origin included: vertebral, hip, humeral head and distal radius and pelvis), current treatment for OP and FRAX index. Results 2.930 postmenopausal women with normal lumbar BMD are included: 505 (17%) had suffered an OP fracture: mean age (SD): 63.2 years (8.5) and of menopause 48 years (10). Among the OP risk factors: early menopause: 818 (28%) women, active smoking: 521 (18%), alcohol &gt; 3 units: 84 (2%), parents hip fracture: 310 (11%). Among osteopenizing diseases: rheumatoid arthritis/chronic arthritis: 112 (4%) patients, inflammatory bowel disease: 44 (2%), arteritis/polymyalgia rheumatica: 35 (1%) and the rest &lt;1%. Among the osteopenizing drugs: omeprazole: 967 (33%) patients, thyroxine: 354 (12%), oral or inhaled corticosteroids: 261 (9%) and aromatase inhibitors: 168 (6%). 427 (15%) patients had had a previous OP fracture: distal radius: 188 (6%), vertebral: 146 (5%), humeral head: 46 (2%) and hip: 47 (2%). 808 (28%) patients were receiving treatment for OP: oral bisphosphonates: 518 (18%), SERM: 136 (5%), strontium ranelate: 75 (3%), denosumab: 51 (2%), teriparatide: 16 (0.7%) and zoledronate: 12 (0.5%) (Table 1). Table 1. Characteristics of patients with normal lumbar spine BMD. TOTAL BMD LS Normal N: 2.930 Normal BMD LS WITH fracture N: 505 (17%) Normal BMD LS WITHOUT fracture N: 2.425 (83%) p Age in BMD, years, mean (SD) 63,2 70.5 (7.78) 60.6 (26) 0.0001 Menopausal age, years, mean (SD) 48 (8.4) 45 (5.46) 48 (8.48) 0.0001 Early menopause, n (%) 814 (28) 171 (34) 643 (27) 0.07 BMI, kg/m 2 , media (SD) 29,1 (10.3) 29.5 (17.03) 28,9 (10.3) 0.44 Active tobacco, n (%) 521 (18) 40 (8) 481 (20) 0.06 Alcohol ≥ 3 units, n (%) 84 (2) 10 (2) 74 (3) 0.85 Parent hip fracture, n (%) 310 (11) 60 (12) 250 (10) 0.65 Ostepenizing drug, n (%): 1.750 289 (57) 1.461 (60) 0.34 Omeprazole 967 (33) 178 (35) 789 (33) 0.60 Thyroxine 354 (12) 53 (10) 301 (12) 0.67 Corticosteroids 261 (9) 42 (8) 219 (9) 0.83 Aromatasa Inhibitor 168 (6) 16 (3) 152 (6) 0.62 Treatment, n (%): 808 (34) 226 (48) 582 (24) 0.0001 Oral bisphosphonate 518 (18) 127 (25) 391 (16) SERM 136 (5) 24 (5) 112 (5) 0.02 Strontium ranelate 75 (3) 20 (4) 55 (2) 1 Denosumab 51 (2) 31 (6) 20 (0.8) 0.35 Zoledronate 12 (0.5) 10 (2) 2 (&lt;0.1) 0.84 Teriparatide 16 (0.7) 14 (3) 2 (&lt;0.1) 0.84 BMD, mean Tscore (SD): Lumbar spine 0.89 0.04 (1.49) 0.05 (1.49) 0.89 Femoral neck 0.70 -1.3 (1.06) -0.54 (1.06) 0.0001 Osteoporosis, n (%) 108 (4) 51 (10) 57 (2) 0.07 Osteopenia, n (%) 981 (33) 247 (49) 734 (30) 0.0001 Total hip -0.31 -0.8 (1.12) -0.17 (1.12) 0,0001 FRAX with BMD, mean (SD): Mean fracture 5.23 10.6 (5.79) 3.99 (5.78) 0.0001 Hip fracture 1.54 3.7 (3.58) 1.09 (3.58) 0.0001 The group with OP fractures, are significantly (Table 1): older (p&lt;0.0001), with lower mean age of menopause (p&lt;0.0001), receive more treatment (p&lt;0.0001), especially oral bisphosphonates (p=0.02), have worse results in hip BMD (p&lt;0.0001), with a higher percentage of osteopenia (50% vs 30%, p&lt;0.0001) and worse result in FRAX of major fracture (p&lt;0.0001) and of hip (p&lt;0.001). Conclusion Among the patients referred to BMD, although the result of lumbar spine is normal, 17% have suffered an OP fracture, presenting this group: 1) Older age, 2) Osteopenia in hip BMD 50%, with high risk of fracture due to FRAX and they followed treatment for OP, especially oral bisphosphonates. 3) It is advisable to simultaneously perform BMD at the lumbar and hip levels, especially in older subjects Acknowledgements The study was supported by a research grant from the Marina Baixa Association for Research in Rheumatology (AIRE-MB). Disclosure of Interests None declared